INS and hyperinsulinism: High IR-related insulin levels also promote Na+-H+ exchange in the renal tubules, enhance the excretion of H+, and favor the reabsorption of UA (39), while renin-angiotensin system activity in response to hyperinsulinemia leads to a drop in blood flow in the kidneys, greater urate reabsorption, and xanthine oxidase production that contribute to higher levels of SUA output (40), McCormick et al.